Abstract

PIP: The Alan Guttmacher Institute takes a critical look at the practical aspects of obtaining and providing the hormonal implant Norplant in the US service delivery system. It focuses on financial accessibility of the implant and raises questions about the role of service providers in implant counseling and removal. In the US, access to a complete range of contraceptive options usually hinges on income and insurance coverage. Since the initial price of Norplant is high ($365), the public sector cannot assure a full range of methods. The price precludes most low-income women who do not quality for Medicaid from using Norplant. Many people want the price to be reduced, particularly because a private foundation and public funds shouldered much of its development costs. In some cases, the private company and publicly funded contraceptive development organizations have negotiated a price reduction for public sector family planning providers. The current debate over national health care financing must result in coverage of contraceptive services and supplies for all methods. Safeguards must be in place to make sure that women voluntarily choose the implant and continue to use it. Providers need to counsel women about all the risks and benefits of each contraceptive method, potential side effects, and how to obtain financial and clinical access to start, continue, and discontinue method use. Family planning providers need to put as much attention on access to removal as on access to insertion. For example, the initial fee could include the cost of removal. The Population Council and health agencies in California, Florida, and North Carolina provide guidelines for implant provision and on informed and voluntary method choice. Public policy needs to uphold equal access to use and to discontinuation of methods, especially when public funds have been used.